Managing heart failure in a specialist clinic.

Patients with heart failure are often inadequately investigated and treated in general practice. To improve the management of heart failure locally we initiated a specialist clinic in 1994. After its first 18 months, we audited the outcome of general practitioners' referrals to the clinic to examine its effectiveness in improving the diagnosis and treatment of heart failure. Eighty-five patients were referred with suspected heart failure. However, only 48% had echocardiographic evidence of left ventricular systolic dysfunction. Following referral, 80% of these patients were given a trial of angiotensin-converting enzyme inhibitors compared with 27% before referral. Six patients were receiving angiotensin-converting enzyme inhibitors unnecessarily, and five patients had significant structural cardiac disorders. Referral to a specialist clinic improved the accuracy of diagnosis and the number of patients on appropriate treatment. Greater use of open access echocardiography prior to referral might have allowed a more selective (and cost-effective) utilisation of the clinic.